Rheumatology Health Library

Arthritis and rheumatic diseases

Regularly grouped together under the umbrella term “arthritis” — which can refer to 100-plus different types of diseases and conditions — rheumatic diseases are autoimmune, inflammatory, degenerative ailments that cause the body’s immune system to attack the joints, bones, muscles, and organs. Rheumatic diseases can appear in places all over the body, affect patients of all age groups, and vary greatly in severity.

One characteristic of rheumatic disease includes inflammation (which often leads to swelling, redness, and/or a feeling of heat, and pain in the affected areas. Another characteristic is a possible decrease in the functionality of affected body parts, often the joints, tendons, ligaments, bones, and muscles.

Some of the most common types of rheumatic diseases and conditions include:

Most often seen in the spine and back, but sometimes affecting joints elsewhere such as the hips and shoulder, ankylosing spondylitis is a chronic (long-term) rheumatic disease that causes the joints to become inflamed or even fused together. When the condition affects the spine and back, it can result in a stooped posture in the patient. Further, some patients with ankylosing spondylitis can experience inflammation of the eye and/or issues with the heart valves.

Treatment options for the condition can include weight control, exercises designed to increase range of motion and strengthen muscles used for joint stabilization, and medications including non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and corticosteroids.

A common and highly painful form of arthritis, gout often presents in sudden and severe episodes called gout attacks that lead to swelling and tenderness in the affected areas. It is caused by a buildup of extra uric acid in the body that causes sharp crystals to form in the small joints and/or connective tissue, most commonly in the big toe.

Factors that contribute to gout attacks in a patient can include family history, gender, and age (with adult men being the most commonly affected), being overweight, alcohol consumption, eating purine-rich foods, certain health problems (especially kidney disease, high blood pressure and hypothyroidism), and medications such as diuretics and drugs containing salicylate. Treatment options aimed at reducing the patient’s pain can include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine. Other medications may be administered in an effort to lower the levels of uric acid in the patient’s blood.

Systemic lupus erythematosus — commonly referred to as lupus — is a chronic (long-term) rheumatic disease that sees the body’s immune system attack its own tissues and organs, resulting in swelling and pain that can affect a range of different systems throughout the body. Commonly affected areas include the joints, blood cells, skin, kidneys, brain, heart, and lungs. The disease’s hallmark symptom, a facial rash that spreads across both cheeks in a shape similar to a butterfly’s wings, occurs in many lupus cases but doesn’t always appear. And because the disease’s signs and symptoms can be similar to those of other ailments, it can often be a challenge to diagnose.

The primary symptoms of lupus can include swelling, redness, heat, and pain in affected parts of the body. Other symptoms can include fatigue, fever, pain and stiffness in the joints; mouth ulcers; heightened sensitivity to sunlight; blood-related issues such as anemia; shortness of breath; hair loss; and neurologic issues such as seizures and psychosis. Heart and lung issues can also develop in patients with lupus. There is currently no cure for lupus, but treatment options aimed at preventing/reducing flare-ups and minimizing complications can include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid hormones, immunosuppressive drugs, and disease-modifying antirheumatic drugs.

Lyme disease is an illness caused by borrelia bacteria and typically resulting from a tick bite in humans. Its early symptoms can include a rash that often looks like a target or bull’s-eye, fever, headache, fatigue, muscle aches, and joint stiffness. If allowed to progress to its late stages, lyme disease can lead to a clinical manifestation known as lyme arthritis. This condition is characterized by pain and swelling in the large joints, most commonly the knee, but also appearing in the shoulder, ankle, elbow, jaw, wrist or hip. Unlike rheumatoid arthritis, this type of arthritis tends to be sporadic and, rather than producing more widespread effects, typically appears in two to three joints. Initial episodes of lyme arthritis are typically treated with antibiotics, with an additional course given if swelling or pain persist or recur.

A common type of arthritis also known as “wear and tear arthritis,” osteoarthritis is a result of the gradual breaking down and wearing down of the cartilage that cushions the joints throughout the body. As a result, the bones are left without their former cushioning at these joints, allowing them to rub together and causing pain and swelling, along with a reduction in or loss of mobility at the joint. The pain and stiffness that osteoarthritis causes also tend to worsen over time, often creating difficulty in carrying out daily activities. While there is no cure for osteoarthritis, treatment options can help affected patients better control their pain and remain active. These can include lifestyle changes, anti-inflammatory and pain-reducing medications, and physical therapy, as well as surgical options such as arthroscopy, osteotomy, joint fusion, and joint replacement.

A crucial part of the rehabilitation process for many patients who have had joint replacement, movement-limiting injuries, and other debilitating conditions, physical therapy (PT) typically involves exercises meant to retrain muscles, rebuild strength, restore function, relieve pain, and regain movement. While the movements involved can bring temporary discomfort for recovering patients, physical therapy is designed (typically by a care provider known as a physical therapist) to speed recovery and restore range of motion.

The exercises involved in PT are usually focused on building flexibility, strength, balance, coordination, and/or endurance. Sometimes, PT programs can also incorporate tools such as electrical stimulation, hot packs, cold compresses, ultrasound devices, traction, and/or deep-tissue massage in an effort to reduce pain and/or swelling in patients. Physical therapists may also be involved in helping patients learn to use tools such as crutches, prostheses, and wheelchairs.

Psoriatic arthritis is a complication that often occurs in conjunction with psoriasis, which is a chronic (long-term) autoimmune condition that causes skin cells to grow at faster-than-normal rates. Psoriasis can cause itchy, scaly skin rashes, typically on the knees, elbows, scalp, and torso. These rashes tend to occur in cycles, flaring up for a few weeks or months, then going away for a period of time before reappearing.

Psoriatic arthritis is a condition that (like other types of arthritis) can lead to pain, stiffness, and swelling in the joints of affected patients. A rheumatic disease that develops in about one in 10 psoriasis patients, psoriatic arthritis can affect a single or multiple joints and sometimes affects just one side of the body. While there is no cure for psoriatic arthritis, early treatment of the condition can help reduce the joint damage it can cause. Pain-relieving treatment options can include physical therapy and exercises, along with medications such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs). When psoriatic arthritis cases are severe, drugs aimed at suppressing the immune system may be employed, with tumor necrosis factor-alpha (TNF-alpha) inhibitors presenting an additional treatment option.

Also referred to as Reiter’s syndrome, reactive arthritis is a type of arthritis that sets in as a result of (or “reaction” to) an infection in another part of the body, often the intestines or urinary tract. The condition produces symptoms that can include pain, swelling, redness, and a feeling of heat in the joints (often the knees, ankles, and/or feet) — and, in some cases, redness and inflammation in the eyes, along with urinary tract inflammation. Treatment options for reactive arthritis can include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, topical corticosteroids, and antibiotics.

Also referred to as reactive arthritis, Reiter’s syndrome is a type of arthritis that sets in as a result of (or “reaction” to) an infection in another part of the body, often the intestines or urinary tract. The condition produces symptoms that can include pain, swelling, redness, and a feeling of heat in the joints (often the knees, ankles, and/or feet) — and, in some cases, redness and inflammation in the eyes, along with urinary tract inflammation. Treatment options for reactive arthritis can include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, topical corticosteroids, and antibiotics.

Considered both a rheumatic disease and an autoimmune disease, rheumatoid arthritis sees the body’s immune system attack the protective and lubricating lining of the joints, called the synovium. Commonly affecting the hands, knees, or ankles — and typically appearing in the same joint on both sides of the body — rheumatoid arthritis causes the synovium to become inflamed, leading to warmth, redness, pain, and a reduced range of motion in affected patients. With disease progression, the synovium can intrude upon and cause damage to the cartilage and bone of the affected joint(s), in the process sometimes also weakening the surrounding muscles, ligaments, and tendons. It can also lead to more generalized bone loss and, eventually, osteoporosis, in addition to causing problems in other parts of the body, such as the eyes, heart/circulatory system, and lungs.

Common symptoms of rheumatoid arthritis include tender, warm, swollen joints, with joints typically affected in a symmetrical pattern; joint inflammation, pain, and stiffness; fatigue; occasional fever; and a general malaise. Treatment options can include stretching and strengthening exercises, application of heat and/or cold to the affected joints, protection of joints with braces or splints, and electrical nerve stimulation. Other options include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biologic response modifiers, corticosteroids, and costimulation modulators. Surgical procedures such as joint replacement and joint fusion may be considered in extreme cases.

As both a rheumatic disease and a connective tissue disease, scleroderma is a chronic (long-lasting) but rare condition that can cause swelling and pain in the joints and muscles, as well as a hardening, tightening, or thickening of the skin (the most commonly affected body part), blood vessels and internal organs. The condition sees normal, healthy tissue in the body get replaced by a thick, dense fibrous tissue — a process similar to that of scarring that takes place as a result of the immune system triggering cells in affected areas to produce too much of the protein collagen. The condition has two main types:

  • localized scleroderma, in which hard, oval patches or streaks develop on the skin
  • systemic (generalized) scleroderma, in which the condition’s signature thickening and hardening can affect connective tissue throughout the body, including the skin, esophagus, gastrointestinal tract, lungs, kidneys, heart, and other internal organs, in addition to the blood vessels, muscles, and joints

Treatment options for scleroderma, which has no current cure, are largely focused on relieving symptoms of the condition and limiting the damage that it causes.

An inflammation of the membrane (called the synovium) that lines the moveable joints in the body such as the knees, the shoulders, and the hips, synovitis is categorized into two main types — transient (or toxic) synovitis and arthritis-associated synovitis. Transient synovitis is a common, sudden-onset cause of hip pain among children, typically between the ages of 3 and 10. It can cause affected children to walk with a limp or have other problems with walking, and it usually resolves on its own within seven to 10 days. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce a patient’s pain, and persistent cases may call for arthroscopy to remove inflamed tissue. Synovitis associated with arthritis is most often seen in the knees, shoulders, or hips of patients with rheumatoid arthritis, psoriatic arthritis, gout, or lupus. Other, smaller joints such as those in the wrist, fingers, and ankles can also be affected. Symptoms of arthritis-associated synovitis include pain, warmth, and swelling in the affected joint, and a progression of the condition can result in damage to the cartilage and bone of the joint as a result of the synovium’s inflammation. Treatment options for arthritis-associated synovitis include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids.

Tendinitis is the inflammation (characterized by redness, soreness, and swelling) of a tendon, which is a connective tissue in the body that attaches muscle to bone. Caused by overuse, injury, infection, diseases such as arthritis or diabetes, or abnormal joint positioning, tendinitis can lead to pain and stiffness in patients that is intensified by movement or that flares up when the patient is trying to sleep. Common treatment options include rest, splints, or other supports that restrict movement, anti-inflammatory medications and/or corticosteroid injections, administration of ice or moist heat, physical therapy, and (in severe cases) surgical procedures such as arthroscopy.

Transient synovitis is a common, sudden-onset cause of hip pain among children, typically between the ages of 3 and 10. It can cause affected children to walk with a limp or have other problems with walking, and it usually resolves on its own within seven to 10 days. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce a patient’s pain, and persistent cases may call for arthroscopy to remove inflamed tissue.